Medical Residency: When Are Program Administrators Liable?

Dibb, Cameron Bruce, Journal of Law and Education

I. INTRODUCTION

The United States is experiencing a health care problem that has yet to be solved by politicians, physicians, insurers, and other interest groups. Specifically, the medical profession is undergoing a medical liability crisis which, unfortunately, does not appear to have a resolution to its evolution. As the effects of medical liability continue to grow, medical schools and residency programs are also feeling the influences of liability risks.

Medical school graduates are required to participate in a hospital based residency program in order to certify in particular specialty or subspecialty areas. Successful completion of a residency program is a prerequisite for board certification in most specialties. The goal of graduate medical education or residency programs is to provide excellent training with an appropriate balance between educational and clinical areas of instruction. As residency programs educate and train their residents, they expose themselves to liability lawsuits brought by both patients and residents.

There are no specific United States Supreme Court holdings determining when residency program administrators are liable. However, the Accreditation Council for Graduate Medical Education ("ACGME") residency program standards, as well as cases in various courts throughout the United States, set out a pattern of how courts should decide liability with regard to residency programs.

First, residents have filed claims alleging their graduate medical education administrators tortiously failed to provide adequate educational services ("educational malpractice"). Most educational malpractice suits are based on claims that the program's education and training were insufficient or non-existent. Program administrators have successfully used the defense that there are national education policies and guidelines that residency programs must follow in order for the residents to be certified to practice. The courts have deemed these national policies, provided by the ACGME, valuable in determining whether administrators are liable for educational malpractice.1

Second, residents who were dismissed from programs or were not certified to practice medicine have filed breach of contract claims. ACGME policies require programs to sign contracts with residents. Some courts have held that residency program administrators are not liable for breach of contract claims if the program administration is following the ACGME policies and acting for academic purposes. The program administration can be liable, however, for breach of contract if the institution failed to fulfill a specific contractual commitment required by the ACGME.

Finally, students as well as patients have filed claims challenging the supervising and administration of routine policies and procedures created by the program administrators. When supervising and creating policies that the residents must follow, program administrators will not be held liable if they follow ACGME guidelines and set administrative standards that are reasonable. Only when the standards set by the residency administration are unreasonable, or when it is known by the administration that they are not being followed, can a program be held liable.

II. NATIONAL ACCREDITATION RESIDENCY PROGRAM STANDARDS

The ACGME is a private not-for-profit organization responsible for the accreditation of more than 7,800 post-medical degree training and educational programs within the United States.2 Completion of an accredited residency program is a prerequisite for primary board certification and for certification in the majority of subspecialty boards.3 Accreditation is essential for a program's validity. It also serves as a national monitor. The ACGME establishes national standards for graduate medical education by which it approves and continually assesses educational programs under its sponsorship.4

Accreditation was developed to protect the interests of residents, benefit the public, and improve the quality of teaching, learning, research, and professional practice. …

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